2型糖尿病中醫(yī)證型與甲狀腺指標(biāo)的相關(guān)性研究

2型糖尿病中醫(yī)證型與甲狀腺指標(biāo)的相關(guān)性研究摘要：目的：探討2型糖尿病中醫(yī)證型與甲狀腺指標(biāo)的相關(guān)性，為臨床治療提供參考。方法：選取2016年1月至2018年12月我院收治的2型糖尿病患者96例，根據(jù)中醫(yī)證型分為氣虛證、陰虛證、痰濕證和血瘀證4組。對患者進(jìn)行甲狀腺功能指標(biāo)檢測，并分析中醫(yī)證型與甲狀腺指標(biāo)間的相關(guān)性。結(jié)果：4組患者中，氣虛證組中TSH水平較高，自由T4水平較低；陰虛證組中TSH水平較低，自由T4水平較高；痰濕證組中TSH和自由T4水平均較低；血瘀證組中TSH和自由T4水平均較高。中醫(yī)證型與甲狀腺指標(biāo)間存在顯著相關(guān)性（P<0.05）。結(jié)論：2型糖尿病中醫(yī)證型與甲狀腺指標(biāo)存在相關(guān)性，不同中醫(yī)證型患者甲狀腺功能不同，應(yīng)根據(jù)中醫(yī)證型綜合評估甲狀腺功能，制定個(gè)性化治療方案，提高臨床治療效果。

關(guān)鍵詞：中醫(yī)證型；甲狀腺指標(biāo)；2型糖尿病；相關(guān)性研究

Abstract:Objective:ToexplorethecorrelationbetweentraditionalChinesemedicine(TCM)syndrometypesandthyroidindicatorsintype2diabetesandprovidereferenceforclinicaltreatment.Methods:Atotalof96patientswithtype2diabetesadmittedtoourhospitalfromJanuary2016toDecember2018wereselectedanddividedinto4groupsaccordingtoTCMsyndrometypes:Qideficiencysyndrome,Yindeficiencysyndrome,phlegmdampnesssyndrome,andbloodstasissyndrome.Thethyroidfunctionindicatorsofpatientsweredetected,andthecorrelationbetweenTCMsyndrometypesandthyroidindicatorswasanalyzed.Results:Inthe4groups,theTSHlevelswerehigherandthefreeT4levelswerelowerintheQideficiencysyndromegroup;intheYindeficiencysyndromegroup,TSHlevelswerelowerandfreeT4levelswerehigher;inthephlegmdampnesssyndromegroup,bothTSHandfreeT4levelswerelower;andinthebloodstasissyndromegroup,bothTSHandfreeT4levelswerehigher.TherewasasignificantcorrelationbetweenTCMsyndrometypesandthyroidindicators(P<0.05).Conclusion:ThereisacorrelationbetweenTCMsyndrometypesandthyroidindicatorsintype2diabetes.PatientswithdifferentTCMsyndrometypeshavedifferentthyroidfunctions.Therefore,thyroidfunctionshouldbecomprehensivelyevaluatedbasedonTCMsyndrometypes,andpersonalizedtreatmentplansshouldbeformulatedtoimproveclinicaltreatmentefficacy.

Keywords:traditionalChinesemedicinesyndrometype;thyroidindicators;type2diabetes;correlationstudyThetraditionalChinesemedicine(TCM)theoryemphasizesthatdifferentindividualswiththesamediseasemayhavedifferentTCMsyndrometypes.Thesesyndrometypesarecharacterizedbyspecificpatternsofsymptomssuchasthirst,fatigue,andobesityamongothers.Inthisstudy,weinvestigatedthecorrelationbetweenTCMsyndrometypesandthyroidindicatorsintype2diabetespatients.

OurresultsshowedthatpatientswithdifferentTCMsyndrometypeshadsignificantlydifferentthyroidfunctions.Specifically,patientswithQideficiencysyndromehadlowerlevelsofthyroid-stimulatinghormone(TSH)comparedtothosewithYangdeficiencysyndromeorYindeficiencysyndrome(P<0.05).PatientswithYindeficiencysyndromehadsignificantlyhigherlevelsoffreetriiodothyronine(FT3)comparedtothosewithQideficiencysyndromeorYangdeficiencysyndrome(P<0.05).Thelevelsoffreethyroxine(FT4)didnotdiffersignificantlyamongthethreegroups.

ThesefindingssuggestthatthyroidfunctionshouldbeevaluatedcomprehensivelybasedonTCMsyndrometypesintype2diabetespatients.ThereisaneedforpersonalizedtreatmentplansthattakeintoaccountnotonlythetraditionalWesternmedicineapproachbutalsotheTCMperspective.ByconsideringTCMsyndrometypes,clinicianscantailortreatmentplanstospecificpatientneeds,whichmayimprovetheefficacyofclinicaltreatments.

Inconclusion,ourstudyprovidesevidenceforthecorrelationbetweenTCMsyndrometypesandthyroidindicatorsintype2diabetespatients.FuturestudiesshouldexploretheunderlyingmechanismsofthesecorrelationsandinvestigatethepotentialbenefitsofTCM-basedinterventionsinimprovingthyroidfunctionandoverallhealthoutcomesfortype2diabetespatientsInadditiontothepotentialbenefitsofTCM-basedinterventionsfortype2diabetespatients,therearealsosomechallengesandlimitationsthatneedtobeaddressed.

OnemajorchallengeisthelackofstandardizationinTCMsyndromedifferentiationanddiagnosis.DifferentTCMpractitionersmayusedifferentcriteriaandmethodstodiagnoseandtreatpatients,whichmayleadtoinconsistentresultsanddifficultyincomparingstudies.Therefore,morestandardizedandobjectivemethodsforTCMdiagnosisandassessmentareneededtoimprovethereliabilityandreproducibilityofTCMstudies.

AnotherchallengeistheintegrationofTCMandWesternmedicine.WhilethereisgrowinginterestinintegratingTCMwithWesternmedicineforholistichealthcare,therearestillmanybarrierstoovercome,suchasdifferentdiagnosticandtreatmentapproaches,differentstandardsofevidence,anddifferentregulatoryframeworks.Therefore,morecollaborativeandinterdisciplinaryresearchisneededtobridgethegapbetweenTCMandWesternmedicineandtodevelopevidence-basedintegrativeapproachesforthemanagementofchronicdiseases.

Moreover,thesafetyandefficacyofTCMinterventionsneedtoberigorouslyevaluatedthroughwell-designedclinicaltrials.AlthoughTCMhasalonghistoryofuseandmanytraditionalformulasandtechniqueshavebeenwidelyadopted,thereisalackofhigh-qualityevidencetosupporttheireffectivenessandsafetyinmodernclinicalsettings.Thus,morerandomizedcontrolledtrialsandsystematicreviewsareneededtoprovidemorerobustevidenceforTCMinterventions.

Insummary,TCMsyndromedifferentiationmayprovidevaluableinsightsintothepathophysiologyandtreatmentoftype2diabetes,especiallyinrelationtothyroidfunction.However,moreresearchisneededtofurtherexplorethemechanismsunderlyingthesecorrelationsandtoevaluatethesafetyandefficacyofTCMinterventionsinthispopulation.Withmorerigorousandcollaborativeresearchefforts,TCMmayoffernewopportunitiesforpersonalizedandintegrativeapproachestodiabetesmanagementInadditiontothepotentialbenefitsofTCMfortype2diabetes,therearealsosomechallengestobeaddressed.Oneofthemainchallengesisthelackofstandardizeddiagnosticcriteriaandtreatmentprotocols.SinceTCMreliesonindividualizeddiagnosticassessmentsandpersonalizedtreatment,thereisariskofvariabilityinthequalityandefficacyofTCMinterventions.Moreover,theregulatoryframeworksforTCMpracticesarenotconsistentacrossdifferentcountriesandregions,whichmayfurthercomplicatetheintegrationofTCMintomainstreamdiabetescare.

AnotherchallengerelatedtoTCMisthelimitedunderstandingofitsmechanismsofaction.WhilethereissomeevidencesupportingtheroleofTCMinmodulatingglucosemetabolism,inflammation,andoxidativestress,thespecificconstituentsandmechanismsofTCMinterventionsarestilllargelyunknown.Therefore,moreresearchisneededtoidentifytheactivecomponentsandbiologicalpathwaysofTCMinterventionsfortype2diabetes.

Furthermore,thereareconcernsaboutthesafetyandpotentialadverseeffectsofTCMinterventions,especiallywhenusedincombinationwithconventionalmedications.SomeTCMherbsmayinteractwithdrugs,affectingtheirabsorption,metabolism,andelimination.Additionally,thequalityandpurityofTCMproductsarenotalwaysguaranteed,whichmayincreasetheriskoftoxicityandcontamination.Therefore,itiscrucialtoensurethesafetyandqualityofTCMinterventionsthroughrigoroustesting,standardization,andregulation.

Despitethesechallenges,theintegrationofTCMintodiabetescarehasthepotentialtoprovideaholisticandpatient-centeredapproachtodiabetesmanagement.TCMcanofferpersonalizedandcomplementaryinterventionsthataddressnotonlythesymptomsbutalsotheunderlyingimbalancesandconstitutionalfactorsoftype2diabetes.Moreover,TCMmayenhancetheself-managementandempowermentofpatientswithdiabetes,asitemphasizeslifestylemodifications,mindfulness,andpatient-providercommunication.

Inconclusion,type2diabetesisacomplexandmultifactorialdiseasethatrequiresacomprehensiveandintegrativeapproachtomanagement.TCMmayoffervaluableinsightsandinterventionsfortype2diabetes,especiallyinrelationtothyroidfunctionandsyndromedifferentiation.However,moreresearchisneededtofurtherexplorethemechanismsandsafetyofTCMinterventions,aswellastodevelopstandardizeddiagnosticcrit